退行性腰椎管狭窄症手术方式及选择探讨

目的研究退行性腰椎管狭窄症患者不同手术方式的疗效,并且对其选择进行探讨。方法将本院2009年10月～2011年10月43例退行性腰椎管狭窄症患者根据其病情和手术方式分为两组,其中A组20例,主要采用椎板间隙开窗、椎管潜行扩大术;B组23例,主要采用全推板或半推板切除减压、髓核摘除加植骨融合钉棒系统内固定术,比较两组术中的并发症率和术后的优良率。结果 B组的优良率为78.26%略高于A组的75.00%,但通过χ2检验后,P〉0.05,差异无统计学意义;B组的并发症发生率为21.7%,显著高于A组并发症发生率的11.5%,且P〈0.05,差异具有统计学意义。结论椎板间隙开窗、椎管潜行扩大术创伤小、花费少、术后效果优良,且能不破坏脊柱稳定性,但是不适合多阶段狭窄及腰椎存在不稳者;而全推板或半推板切除减压、髓核摘除加植骨融合钉棒系统内固定术虽然有较高的并发症率,但是能够治疗多阶段狭窄及腰椎存在不稳者。因此,在选择术式时,应该坚持在术前进行仔细的临床症状和影像学资料的评估,确定狭窄的程度,以提高疗效,减少并发症发生率。

The operation mode and the choice of degenerative lumbar spinal stenosis

Objective To study the efficacy of different surgical methods of the degenerative lumbar spinal stenosis patients, and to explore its options mode and the choice. Methods Forty three cases of degenerative lumbar spinal stenosis patients from October 2009 to October 2011 in our hospital were analyzed, and all patients were divided into two groups according to their condition and operation methods, A group of 20 patients, mainly in the lamina gap fenestration, spinal sneak augmentation; B group of 23 patients, mainly in the whole push the push plate or half plate removal decompression, discectomy plus fusion and pedicle screw fixation systems were compared intra operative and postoperative complication rate of excellent and good rate. Results The acceptance rate of Group B was 78.26%, it was slightly higher than 75.00% in Group A, but after by χ2 test, P > 0.05, there was no significant difference between two groups; the complication rate of group B was 21.7%, it was significantly higher than 11.5% in group A, difference has statistical significance (P < 0.05). Conclusion There are lots of excellent features in prevertebral space window operation and canalis vertebralis sneak enlargement operation such as small traumatism, underspend, with choiceness effective after operation, and it can not destroy spine stability, but it is not fit for patients with vertebral column multistage narrow and lumbar unsteadiness; while there is high rate of complicating disease using removal and decompression, nucleotomy unite interbody fusion and internal fixation total or half ejector plate, but it can cure patients with vertebral column multistage narrow and lumbar unsteadiness. So we should persevere evaluating the clinical symptoms and Radiographic image datas, insure the degree of narrow before surgery and then to choose the method of surgery, so as to increase the clinical efficacy and reduce the complication rate.